双水平正压通气治疗慢性阻塞性肺疾病急性加重期并发Ⅱ型呼吸衰竭效果的Meta分析与试验序贯分析  

Meta-analysis and Trial Sequential Analysis of the Effects of Bilevel Positive Pressure Ventilation in the Acute Exacerbation of Chronic Obstructive Pulmonary Disease Complicated with TypeⅡRespiratory Failure

作　　者：滕文哲 陈虎 石思瑶 程康耀 王茵[1] TENG Wenzhe;CHEN Hu;SHI Siyao;CHENG Kangyao;WANG Yin(Shanghai University of traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学,上海市201203

出　　处：《中国全科医学》2022年第2期227-235,共9页Chinese General Practice

基　　金：上海中医药大学课程建设项目(2019SHUTCM067);上海市教委预算内课题(2021JX178)。

摘　　要：背景慢性阻塞性肺疾病急性加重期(AECOPD)患者发展为Ⅱ型呼吸衰竭的风险明显增加。在临床治疗中双水平正压通气(BiPAP)被广泛运用于AECOPD患者来纠正呼吸性酸中毒,延缓肺功能进一步恶化,但是BiPAP在该类患者中的治疗效果仍存在着争议。目的系统评价BiPAP对于AECOPD并发Ⅱ型呼吸衰竭患者的治疗效果。方法计算机检索中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库(CBM)、PubMed、The Cochrane Library、Springer、Medline、Web of Science等数据库中关于BiPAP治疗AECOPD并发Ⅱ型呼吸衰竭的随机对照研究(RCT),检索时限从数据库建库至2020-10-01。由两位研究者独立对所检索出的文献进行筛选、提取数据和质量评价。提取第一作者、国家、人群特征、年龄、样本量、试验组及对照组的干预方式、试验组干预频率和时长、评价指标[pH值、二氧化碳分压(PaCO_(2))、氧分压(PaO_(2))、呼吸频率(RR)、气管插管率、不良反应发生率]等信息。采用Review Manager 5.4软件对纳入文献进行Meta分析,使用哥本哈根临床试验中心开发的TSA v0.9完成试验序贯分析。结果共纳入10篇RCT,其中4篇为高质量等级文献,6篇为中等质量等级文献。试验组改善AECOPD并发Ⅱ型呼吸衰竭患者的pH值[MD=0.04,95%CI(0.03,0.04),P<0.05]、PaCO_(2)[MD=-7.22,95%CI(-8.20,-6.24),P<0.05]、PaO_(2)[MD=6.23,95%CI(5.31,7.14),P<0.05]、干预24 h内和24 h后改善AECOPD并发Ⅱ型呼吸衰竭患者的RR[MD=-3.85,95%CI(-4.36,-3.35),P<0.05]、气管插管率[RR=0.50,95%CI(0.32,0.78),P<0.05]的效果优于对照组。试验组患者腹胀发生率[RR=5.95,95%CI(1.79,19.77),P<0.05]、面部皮肤受损发生率[RR=8.04,95%CI(1.92,33.76),P<0.05]高于对照组。试验序贯分析结果得出了肯定的结论,即BiPAP治疗能明显改善AECOPD并发Ⅱ型呼吸衰竭患者的pH值、PaCO_(2)、PaO_(2)、RR和气管插管率。结论AECOPD并发Ⅱ型呼吸衰竭�Background Patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)have a significantly increased risk of developing typeⅡrespiratory failure.In clinical treatment,BiPAP is widely used in this kind of patients to correct respiratory acidosis and delay the deterioration of lung function,but the therapeutic effect of BiPAP in this kind of patients is still controversial.Objective To systematically review the effect of BiPAP intervention on the treatment of patients with AECOPD complicated with typeⅡrespiratory failure.Methods CNKI,Wanfang Database,CQVIP,CBM,PubMed,The Cochrane Library,Springer,Medline,and Web of Science were retrived by computer for the RCTs published from inception to October 2020 regarding the application of BiPAP in patients with AECOPD complicated with typeⅡrespiratory failure.Two researchers independently screened the retrieved documents,extracted data and evaluated the quality.The first author,country,population characteristics,age,sample size,intervention methods of the experimental group and control group,frequency and duration of intervention of the experimental group,outcome indicators[pH,partial pressure of carbon dioxide(PaCO_(2)),partial pressure of oxygen(PaO_(2)),respiratory frequency(RR),tracheal intubation rate,incidence of adverse reactions]and other information were extracted.The Review Manager 5.4 software was used to conduct a meta-analysis of the included literature,and the TSA v0.9 developed by the Copenhagen Clinical Trial Center was used to complete the trial sequential analysis.Results A total of 10 RCTs were included,of which 4 were of high quality and 6 were of medium quality.The experimental group could improve the pH value of patients with acute COPD and typeⅡrespiratory failure[MD=0.04,95%CI(0.03,0.04),P<0.05],PaCO_(2)[MD=-7.22,95%CI(-8.20,-6.24),P<0.05],PaO_(2)[MD=6.23,95%CI(5.31,7.14),P<0.05],could improve the RR of patients with acute COPD onset and typeⅡrespiratory failure within 24 h and after 24 h of intervention[MD=-3.85,95%CI

关 键 词：肺疾病 慢性阻塞性 呼吸功能不全 双水平气道正压通气 系统评价 Meta分析 治疗结果 

分 类 号：R563.9[医药卫生—呼吸系统] R563.8[医药卫生—内科学]